How can you calm somebody during an episode of persecutory delusions?

You mentioned in one of your posts that it is not possible to talk somebody "out of it", but what in practice is the best thing to do when your friend drives on the motorway, gets completely stressed and thinks that it is his psychiatrist who sent all these people after him to chase him down, or that members of a political party are placed everywhere to watch him, and everybody else?

After an episode like that, does a schizophrenic actually remember what they thought and felt - does it register in their mind as a real memory, do they realise that they had a bad episode when they didn't make sense, or do they simply not remember anything at all?

I really appreciate your question and wish I had a simple answer for you.

If your friend really trusts you, is aware that he is schizophrenic (I assume he is based on what you said), and is not floridly psychotic (meaning, they are not completely out of touch with reality), you maybe able to have a little influence. You may be able to remind him that these thoughts are part of his illness and that although it feels very real to him, it's not. From there you could perhaps suggest that you drive (if he'll let you) or to go home rather than anywhere else, so he'll feel safe.

Unfortunately, the stronger the delusions, the less influence anyone can have because the person's so convinced that what they believe and feel is real. It would be like someone trying to convince you (after you've turned the stove on) that it isn't hot so go ahead and put your hand on it - you won't get burned. No matter how much they try to persuade you, you know otherwise and aren't about to do something that would be both painful and harmful.

That's how it feels to someone who is dealing with paranoid or persecutory delusions and someone is trying to tell him otherwise. I hope that helps to illustrate the point.

If your friend is having these experiences, he probably should see his treatment provider (if he has one) and have his medication adjusted. If the symptoms are putting him or others in harms way (which could happen if he's driving and things someone is chasing him) then he may need inpatient treatment.

As for whether or not they remember the event as a real memory. Some people do, and some don't. Also, some people remember some times, but not others. It really varies from one person to the next, and may also vary from one episode to the next. Some people may repress the memory as well.